- Work with members, Medical Consenters, staff and providers to meet the behavioral healthcare needs of each member's condition.
- Identify members who may benefit from service management, conduct an assessment and develop, implement and monitor a behavior healthcare service plan.
- Provide information to staff to facilitate development of the behavior healthcare service plan.
- Update database regularly with most recent Service Management Plan of Care.
- Review information submitted by providers into the database to ensure material is appropriate and consistent with guidelines for data inclusion.
- Encourage behavioral health providers to use evidence-based practices and confirm that behavioral health providers and PCP's are sharing information as required.
- Comply with established referral, pre-certification and authorization policies, procedures and processes by related medical management staff.
- Maintain compliance with federal and state regulations and contractual agreements.
- Coordinate service management functions with other departmental functions.
- Monitor data to address trends or potential quality improvement opportunities.
- Maintain HIPAA compliance.
- 4 years of clinical nursing experience in clinical acute care - Emergency Room (ER), In-patient/ Outpatient, Assisted Living, SNF, STAR Plus, Medicaid/Medicare, or RN utilization review for psychotropic medication treatment plans.
- Clinical knowledge and ability to determine overall health of member including treatment needs and appropriate level of care is preferred.
- Must be able to concentrate and multitask between phone calls, emails, meetings, IMs for the entire 8-hour shift
- Strong clinical documentation skills and clinical knowledge with ability to determine overall health of member including treatment needs and appropriate level of care preferred.
- Must be proficient using different computer programs to research information.
- Role requires strong attention to detail, organizational and time management skills.
- Must be highly adaptable/flexible to changes and skilled at learning new processes.
- Skilled to work in a fast-paced environment. Must have strong analytical and problem solving skills.
- Excellent customer service, emotional intelligence, and listening skills with members, providers, clinical staff, and managers is essential.
- Proficient computer skills, and experience working within large databases, provider information systems, and Microsoft Office applications.
- The ability to use multiple avenues of communication proficiently (e.g. phone calls, IMs, email, phone, video conferencing) is 90% of the role responsibilities.
- Ability to collaborate with team members and work independently.
- Comfortable using digital video conferencing platforms (Zoom, MS Teams).
- Knowledge of Medicare and Medicaid regulations preferred.
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Behavior Service, RN, LCSW, LPC - Santa Fe, United States - Centene Corporation
Description
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team.
Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.NOTE:
Registered Nurse (RN) applicants are preferred.
RNs who reside in an approved Nursing Licensure Compact (NLC) state must be licensed for the state of TEXAS.
Work Schedule:
Monday - Friday 8am - 5 pm (CST)
Position Purpose: Perform duties related to the day-to-day operations of the Service Management functions for members to achieve the highest possible levels of functioning and wellness by ensuring consistent, timely access to medically necessary behavioral health services. Monitor quality of care, assist with discharge planning.
Education/Experience: Master's degree in Behavioral Health (e.g. social work, counseling, psychology) or a Nursing graduate from an accredited nursing program AND 3+ years of case management and/or utilization management experience. Experience in psychiatric health care settings, behavioral health conditions and members with special needs. Working knowledge of utilization review procedures, and familiarity with mental health community resources. Thorough knowledge of a specialized or technical field such as clinical nursing, case and/or utilization management involving knowledge plus the application of basic theory.
License/Certification: Unrestricted license as a LCSW, LPC, or RN is required.
Preferred Experience:
Pay Range:
$ $46.68 per hour
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
